John O. Davies-Cole, PhD, MPH State Epidemiologist DC Department of Health
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Disaster Epidemiology Workshop 57 th Presidential Inauguration Health Surveillance: Strength through collaboration John O. Davies-Cole, PhD, MPH State Epidemiologist DC Department of Health
John O. Davies-Cole, PhD, MPH State Epidemiologist DC Department of Health
John O. Davies-Cole, PhD, MPH State Epidemiologist DC
Department of Health
Slide 2
Introduction Every four years - District hosts the Presidential
Inauguration Post 9/11 era - heightened security at high profile
public events. Increased public health surveillance to detect
possible exposure to bioterrorism disease agents such as anthrax,
ricin, tularemia Weapons of mass destruction (WMD) Preparation for
high profile event, DC DOH responsible for implementing active
surveillance activities and conducting epidemiological
investigations.
Slide 3
Health & Medical Subcommittee DHHS DC HSEMA US Capitol JOC
US Capitol Police EOC DC DOH DC PHL DC EHS JTF NCR JOC DHS/Off of
Hlth Affairs Veterans Affairs/VHA FBI WFO CDC FDA DoD MD DHMH VDH
MD MIESS NVERS DC EMS
Slide 4
HEALTH SURVEILLANCE, INFORMATION SHARING & LABORATORY
SUPPORT SERVICES WORKGROUP OBJECTIVES Analyze known and anticipated
requirements to support the Pre-Event, Event, Incident within the
Event, and Post-Event support activities. Develop planning document
that will serve as an Annex following the guidance template. The
combined Annexs will support and complete the CONOPS.
Slide 5
TASKS Consider two scenarios when developing the CONOPS Winter
weather (cold, snow, ice) followed by negative impacts on
infrastructure (e.g. power loss) Multiple attacks transportation
system, bio-agent release, Each work group member will have access
to the restricted share point site where documents and sharing of
ideas, concepts, etc will be located.
Slide 6
Health Surveillance Activities January 7 February 4, 2013
District of Columbia Base of Operation: Data Fusion Cell Inaugural
Event Field Surveillance Sites (Patient Tracking): National Mall
Inaugural Parade Route Inaugural Balls
Slide 7
Health Surveillance Strategies Outline plan for disease
surveillance Identify surveillance systems used for detecting
possible bioterrorism events, tracking seasonal influenza, and
preparing for pandemic flu outbreaks Describe the use of identified
systems in detecting possible disease outbreaks associated with
attendance at the 2013 Presidential Inauguration Discuss
collaborative efforts for health surveillance
Slide 8
Authorities and References: Section 319 of the Public Health
Service Act: Title 42, section 247d Section 319F-3 of the Public
Health Service Act (42 U.S.C. 247d-6d) Threat: No specific threats
identified for this event beyond the typical threats faced by this
region weather, weather related affects on the infrastructure,
extremists, and lone offenders. 2013 Presidential Inauguration
Health Surveillance
Slide 9
Anticipated Attendance Anticipated attendance for the 57 th
Presidential Inauguration: Approx. 300,000-600,000 people. Based
upon historical data for this event prior to the 56 th Presidential
Inauguration.
Slide 10
Surveillance Objectives To provide health surveillance
activities related to the 57 th Presidential Inauguration occurring
two weeks prior and two weeks following January 21, 2013. To alert
decision makes of any unusual health outcomes that may occur during
the inaugural activities Provide a demographic and health profile
of illness & injury Respond to disease outbreaks or other
health emergencies
Slide 11
SYNDROMIC SURVEILLANCE
Slide 12
Hospital Emergency Department Syndromic Surveillance Sites
Region No of Hospitals DC ................................5
Montgomery County, MD. 6 Prince Georges County, MD 3 Northern
Virginia .15 Howard University Hospital
Slide 13
Data Collection Data include: Personal identification
Demographics Chief complaints Symptoms Time/location variables
Paper forms available as backup
Slide 14
Initiation Protocol
Slide 15
Initiation of protocol Data review protocol should be initiated
no less than 2 hours prior to when report should be posted to allow
time for consultation, if needed. The report should be posted to
the Pebble site once per day no later than 1pm. The exception to
the report schedule is the day of the Inaugural event (January 21)
when data should be reviewed and a report posted twice per day
(report times TBD).
Slide 16
Review Time Series for each of the following: SyndromesSub
Syndrome Bot_Like Fever GI Hem_Ill Loc_Les Lymph Neuro Other Rash
Resp SI_Death ILI Trauma
Slide 17
ESSENCE ANCR Report Generation Protocol Creating a report for
Pebble site A report can be generated by going to the More tab on
the ANCR website tool bar then selecting the Daily Report option
Geography of NCR Jurisdictions No jurisdictions should be
highlighted; an explanation of NCR jurisdictions will be posted on
the Pebble site header.
Slide 18
AID STATIONS
Slide 19
Data Sources HHS DoD ESSENCE Red Cross FDA EMS
Slide 20
Field Staffing Site Manager Site Coordinator Nurse Stationary
EMT Roving EMT Administrative Assistant
Slide 21
Equipment Laptop computers: data from AID stations
Communication Devices: To communicate among field staff, data
collection staff and base staff
Slide 22
The Maryland Institute for Emergency Medical Services Systems
(MIEMSS) Introduced HC Standard - HC Patient Tracking Application
Provide real time (one minute delay) situational awareness Utilizes
bar code scanners (such as the handheld Motorola MC75 3G) Scanners
allow patient information to be entered, including patient
demographics, vitals, chief complaints, field treatment,
photographs, sound, and video.
Slide 23
Handheld scanner used in patient tracking
Slide 24
Reporting Epidemiologists responsible for generating
descriptive reports Chief complaint description by time Total
number of persons seen at AID stations Geographic distribution of
persons seen at AID stations
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Slide 32
What Worked Well Planning: Meetings well attended, productive,
and ensured strong regional collaboration between DC, Maryland and
Virginia. Credentialing: Proper credentialing made it easy to move
from place to place Food Safety Response Team: FDA fully
credentialed Data Fusion Center: One centralized data center
Surveillance: First AID Station - Real time data transmission
Surveillance: Enhanced ED Surveillance: epidemiologists from
regional jurisdictions monitored the reports daily in an effort to
detect any unusual disease pattern
Slide 33
Challenges Planning: strong participation from some of the
federal agencies that played important roles in the event needed.
Credentialing: major hindrance to a successful operation during
this inauguration. Food Safety Response Team: FDA and DOH need to
merge collection efforts. Data Fusion Center: Members of the Data
Fusion Center were removed from TVs and therefore had a harder time
following the progress of the days events. All data not received as
planned. Surveillance: First AID Station - Patient trackers were
not pre-deployed, therefore delaying data flow. Volunteers did not
have proper training. Surveillance: Enhanced ED Surveillance: Not
clear about the usefulness of the Pebble site.